Honoring Alice

Ebola

Remember the time when someone you love died and when you felt so lost you had no grounding upon which to stand?  Remember when someone, a stranger or friend, held you and in that moment you felt stable?  Remember when you, yourself, lay sick in a hospital bed and the nurse touched your arm to say, simply, “I’m here with you.”  Remember when, alone, feeling judged, even hated, for something you had done, a time when you were not welcome, when you were not accepted for what had gone in the past, for the color of your skin, for the religion to which you held dear, for being in the wrong place at the wrong time– and remember when someone advocated for you, when they said to the crowd, this person is fine, just as they are?

Now, let me tell you about Alice.

We met in the back of a crowded van in the Port Loko District of Sierra Leone.  She, a nurse, specializing in psychological care, the only psych nurse in the Port Loko District and one of a small handful of nurses with that focus in the whole country. She sat bitch.  I, too, as we were crammed in the back of the van, four people on a bench made for three.  We were sardines in a van of case workers, an imam, a preacher and a couple of other nurses en route to meet a rural community which had lost too many people to Ebola.  We were scheduled to support a discussion—Ebola sex ed.Alice’s cheeks glowed as she taught me what I could and could not say.  She was the only woman in the van and she was soon to take on all the females in the community while the men would meet with men to talk about the importance of condoms, how Ebola was spread and the limited thinking that we knew about the disease’s remnants in survivors.  At the time we were hearing rumors of women who were infected by a man who had been negative for Ebola for six weeks or more.  We thought that the disease still lived in the sperm even after the body was no longer—for a long time—symptomatic. In the back of the van she taught me about taboos.

“We don’t talk about sex. We’re not even supposed to have it,” Her laughter was a harmonic resonation of the pocked roads over which we tumbled. “We all know it happens–we’re all human.”

She had a daughter and a family who lived hours away from where she worked.  Alice was stationed by the regional government to care for Ebola patients at a distant treatment center.  Her roles were as dynamic as her wisdom.  In the mornings she visited patients, mostly children, who watched their parents or friends die the night before.  She was one of the care takers who did not inflict pain on the patients.  Though we all wore the same white or yellow coverall outfits and only our eyes were visible behind the layers of plastic, inhumane, anti-contagion gear, patients would see her from a distance and, if they could, run to her.  As nurse in the treatment center I would come in armed with needles, bags of fluids, syringes full of caustic antibiotics that we injected into any limited muscular space we could find on our patients.  But Alice was different.  She entered the treatment center armed with oranges and mangoes; soda and sweets.

Alice held the patients.  She distracted them while they received painful procedures. She asked them about their religious beliefs, what they thought about death and what they needed to do to try to survive.  She spoke Krio, Temne and Mende.

When I met Alice, she was wearing her other hat, that of teacher.  She taught me in the van how appropriately talk about sex.  She laughed with the other case workers about patients we had treated.  She joked about how we did not give enough condoms out to Ebola survivors when we sent them home.

“They just survived Ebola…come on…they will be very very busy when they get home!”

We also gave survivors cash money, food stores and a sim card.  She commented on patients who received all of these gifts and then asked for more.  “What were we?  A resort?”

She balanced gallows humor with joy and with education.  She balanced family with work, though at the end of that day she told me how dearly she missed seeing her daughter.  But she had a duty to her patients and to her country.

We met imams when we crawled, sea-legged from the van.  They had been waiting at a central home with a long front porch.  At the entrance of the home was a drum, worn with age and covered by a perfectly stretched skin the circumference of a small table.  An imam nodded towards it and a middle aged man struck it like the toll of a church bell.  Soon thirty people were standing around us on the porch; we were introduced to the crowd and Alice moved quietly behind the men.  With the support of the community following our endorsement by the imams we shifted the conversation to reproductive health.  Before it moved too far, Alice spoke up, “Now we must separate the group.”

Women sighed with relief, some giggled.  Old men bowed their heads.

All the men walked to one side of the house, women to the the other, and each group stood in a circle to talk.  From the men’s group I could not see the women’s group, but when our group finished its session early because of the lack of questions and silence from the men, I walked around the house and saw that Alice’s group had doubled in size.  The women spoke for a while longer while we kept our distance.  Alice’s group hugged her when she finished talking.

Caregiver, teacher and peacemaker.

After the sessions Alice and the group walked through the community to visit quarantined families.  She helped ensure that the families were receiving the food and attention they needed while spending 21 days or more roped inside of their homes, praying that they would not develop a fever.  Most families at that time were not receiving ample supplements, the broken supply chain did not do rural well.

Alice had been informed that I had developed a close connection with a young child, a nine-year old boy, who survived Ebola.  For the sake of privacy, I will call him, Issa.  We visited a couple of houses, all inhabitants happy to see Alice, all inhabitants asking us for food and supplies.  Alice and her colleague Musa, a nurse originally from Freetown, but who, prior to the outbreak had been raising his family near Philadelphia, pointed out a house to me down the road.  It, like many homes, had the red and white striped tape wrapped around it.  Behind the tape, far from the road, stood Issa.

Although he had survived, he had family members who had been exposed to Ebola and had not yet cleared the 21-day quarantine mark, so his home was still anathema to the community.  Because he had survived, he was theoretically immune to Ebola.  Therefore, he was able to return to his mother and aunts.  Issa saw Musa and I.  He began to cry.  For as many times I tried to give Issa food while he was sick, I also injected him with drugs and held him down while we placed IV’s.  I sat with Issa while his sister died next to him.  I was a harbinger of suffering.

Alice chuckled as she intervened compassionately.

“Issa! Come here.  You have nothing to be afraid of.  They are not here to bring you back to the treatment center.”

She found it amusing that he was so afraid of us.

“Come here.  They will not hurt you; they want to greet you.”

Issa walked over towards us.  We asked how he was and he said he was happy to be home.  We apologized for scaring him and he quickly brushed it off.  He then put his hand out and asked us for an egg. Many children suffered from hypoproteinemia and because we did not have IV albumin (intravenous protein supplementation) we had only hard boiled eggs to provide.  Alice included in her arsenal of treatment center goodies, eggs.  And Issa devoured them, it seemed at times like the egg interventions were the only things we could give him in the treatment center that would elicit a smile.

Alice provided a psychological bedrock at our treatment center.  When she witnessed a patient who was not receiving what she needed, Alice would doff her protective gear and come to the treatment teams telling us how we could improve our care.  Patients confided in her; they told her routes of transmission, how they thought they became infected.  She communicated that with the teams and we were able to reach out to communities where there were heightened concerns for an increased incidence of the disease.  Patients trusted her. Her Alice-ness was ease.

The treatment center was de-commissioned in mid-2015 and soon thereafter Alice was able to return to her daughter and husband.  She continued her work providing psychological and compassionate care to people in Sierra Leone.  The emotional scars of this disease will endure for years, long after the detection of the last case.

Alice became pregnant with her second child and in May of 2016 she underwent a C-section delivery.  The surgery did not go as planned and though Alice’s child, who is perfectly healthy, survived, Alice succumbed to the surgical complications.  She escorted her youngest into this world as she departed.

In 2015, the world lost an estimated 830 women every day because of birth-related complications.  Of those only 5 came from “developed” countries; 550 deaths—per day—were estimated to have taken place in sub-Saharan Africa[1].

What do we have in the resource wealthy world that causes us to account for only 0.6% of daily maternal mortality and what do we have to share?  The answer is complex.  The solutions are obsolete, yet attainable.  They have to be.  It is not right that women, like Alice, who have brought life into the world, saved lives and livelihoods, who have brought council and peace to inordinate numbers of people and families, should die during childbirth

Resources exist in the both the resource wealthy and resource poor worlds, just as knowledge and experience permeates all cultures in all countries.  We have an increasing capacity to share what we have learned in the sciences and we have ever increasing mobility to share our words, knowledge, resources and ultimately compassion with technology.  The heartbreak that I feel when I consider the the loss of Alice’s life is another reminder of the urgency to acknowledge the abyss dividing the resource rich and the resource poor, to talk about it, to use what skills we have to invigorate new thought and new action.  No mother should die from a routine cesarean section in 2016 anywhere on this planet.

*          *          *

If you are so inclined, my colleague Edward Vandi has created a GoFundMe page for Alice’s surviving children and family.  If you care to donate, you may do so here

 

[1] World Health Organization (2015).  Global Health Observatory Data. Retrieved on 21 August, 2016 from:  http://www.who.int/gho/maternal_health/mortality/maternal_mortality_text/en/

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